VA Service To Vets Doesn’t Meet Muster

Have you ever heard a politician say he or she doesn’t support the men and women who have served in the military and now need help through the Veteran’s Administration? So, you’d would think that veteran’s needs are being met in a proper and timely manner. But, that just isn’t the case.

In 2014, the Congress approved a controversial measure called the VA Choice program which was intended to quickly get more veterans into physician’s offices. Lawmakers overwhelmingly approved the program in the wake of wait time scandals in which vets were waiting an average of 51 to 64 days. It also became public news that local administrators were manipulating patient records to hide growing wait times for appointments and to collect performance bonuses.

The Choice program channeled $10 billion for vets to get care outside the VA system and another $2.5 billion for hiring more doctors, nurses and other medical staff at VA medical centers. The number of veterans coming to the VA had shot up in recent years, and the number of medical staff members had not kept pace. The idea was that more caregivers would cut wait times.

The Choice program was intended to let veterans who faced a wait of more than 30 days eligible to see private-sector doctors at taxpayers’ expense. Nonetheless, critics complained that the system was overly bureaucratic and still limited veterans’ access to health care.

Subsequent investigations by National Public Radio and its local member stations found that the number of VA new hires was about the same as the VA would have hired without the additional $2.5 billion; the new hires weren't sent to VA hospitals with the longest wait times; and the VA medical centers that got new hires were not more likely to see improved wait times.

The inspector general also reviewed records of veteran patients who were added to Choice lists and managed to get appointments outside the VA. Auditors found that 82% of them waited longer than 30 days, and on average, they waited nearly three months.

Government Accounting Office (GAO) officials said the VA’s decision not to put stricter timelines for patient requests lead to an average of 51 days for veterans to receive care in late 2016.

“Timeliness of appointments is an essential component of quality health care,” the report stated. “Delays in care have been shown to negatively affect patients’ morbidity, mortality, and quality of life… VA lacks assurance that veterans are receiving care from community providers in a timely manner.”

With the continued long wait lists and short-staffing at VA hospitals across the country, there was talk about privatizing the services of the VA. But major veterans’ groups immediately expressed opposition to the idea, saying the solution is full funding for core VA medical centers. It’s absolutely essential, they contend, to have caregivers who specialize in veterans’ special needs. The private sector cannot replicate VA’s expertise in things like spinal cord injury, traumatic brain injury, rehabilitative services, prosthetics, audiology, services for the blind, suicide prevention.”

The Trump administration picked up the reins of government beginning 2017 and decided to name David Shulkin, an Obama administration 2015 appointee as undersecretary of health for the VA in 2015 as the new Secretary. Issues with the VA did not go away, they persisted and festered. Internal political turmoil among senior officials at the VA became widely publicized over the last year as the turmoil has gotten in the way of serving veterans.

The Veterans Appeals Improvement and Modernization Act of 2017 was enacted in August, 2017, with the intention of taking action to streamline the appeals process for disability compensation claims within the VA. It ends the earlier VA Choice program. The Department of Veterans Affairs (VA) currently spends about $63.7 billion per year on 4.1 million veterans with disabilities related to their time in service.

More than 470,000 veterans are awaiting pending decisions regarding their appeals." The new law gives the VA secretary wide authority to decide when veterans can bypass the VA, based on whether they receive "quality" care, but the program could be restricted by escalating costs.

The law established three new “lanes” for veterans appeals, to separate them out into separate categories and hopefully ease the speed with which they go through, rather than all funneling them together into one bureaucratic catch-all as before.

The “Board lane” instantly moves a pending appeal over to the Board of Veterans’ Appeals and skips the intervening layers of VA hierarchy.

“The local higher-level review lane” moves a rejected claim to another adjudicator higher up on the VA hierarchy to take a second look at.

The “new evidence lane” allows veterans to submit new evidence related to their disability claim.

While the legislation directs the VA to create this structure for appeals, it does not include specific plans for implementation. Rather, the VA is directed to define which appeals will go in which lane and to implement that structure.

The newly expanded program that will take at least a year to implement, and veterans will still have to meet certain criteria before they can see a private physician. In August, 2018, Wilkie made a pledge to the American Legion that he won’t privatize his agency’s health care services, even as it increases options for veterans to seek care in the private sector

Trump fired David Shulkin in March, 2018, after news of Shulkin’s expensive travel was became public. From March until July of this year when Robert Wilkie was formally sworn in, many names were floated as potential replacements including: the former CEO of the conservative organization Concerned Veterans for America, "Fox & Friends" contributor Pete Hegseth, retired U.S. Army Lt. Gen. Keith Kellogg and former president and CEO of the Cleveland Clinic Toby Cosgrove. Even Ronny Jackson’s name, the president’s personal physician, was floated for a while, until his lack of experience leading a large, complex organization such as the VA was called into question.

Robert Wilkie will face multiple challenges leading VA. He is responsible for implementing the new Veterans Appeals Improvement and Modernization Act. Even though Wilkie now heads the service, there is an unofficial troika of Trump’s Mara-a-Logo cronies who are secretly shaping the Trump administration’s veterans’ policies. The troika is led by Ike Perlmutter, the reclusive chairman of Marvel Entertainment, who is a longtime acquaintance of President Trump’s. Bruce Moskowitz is a Palm Beach doctor who helps wealthy people obtain high-service “concierge” medical care. The third member is a lawyer named Marc Sherman. None of them has ever served in the U.S. military or government.

In the meantime, the issues to be dealt with at the VA include:

A Large Population

The nation has roughly 20 million veterans and 4.1 million veterans with disabilities related to their time in service.

Disability Benefits

There are more than 470,000 veterans who have been denied benefits and have appealed. When they do appeal, they encounter an antiquated system where processing cases takes years — and sometimes even decades.

Jonathan Bey is a good case in point. He hurt his back while repairing buoys at sea in the Coast Guard and was discharged. He then filed what he thought would be a routine request for veteran’s disability benefits. But that was 34 years ago. After repeated denials by the Department of Veterans Affairs, appeals by Mr. Bey, and more than a couple of letters saying that the department had lost his files, Mr. Bey is still waiting. His case is not an isolated incident, there are many more vets who have been waiting that long, according to the department. Another 22 have been waiting more than 30 years. And wait times keep growing.

PTSD

A recent sample of 600 veterans from Iraq and Afghanistan wars found that

14% post-traumatic stress disorder; 39% abused alcohol and 3 percent had drug abuse issues. Major depression is also an issue.

Traumatic Brain Injury (TBI)

The rates of TBI injuries are much higher for veterans of modern day wars, defined as Gulf War veterans, due to the concussive forces of modern bombs.

Suicide

Recent statistical studies show that rates of veteran suicide are much higher than previously thought, as much as five to eight thousand a year (22 a day, up from a low of 18-a-year in 2007),

Homelessness

The number of homeless veterans in America was estimated at 49,933 in January 2014, according to the U.S. Department of Housing and Urban Development, the Department of Veterans Affairs, and the U.S. Interagency Council on Homelessness. That was a decline by 33 percent, or 24,837 people, from 2010 due to national efforts to deal with the problem.

More than 40,000 homeless vets receive compensation or pension benefits each month, but it’s not enough to find affordable housing, according to the National Coalition for Homeless Veterans. Many vets have learned skills through the military, but they are not applicable for occupations in civilian life. About 40 percent of homeless vets are African American or Hispanic. About 33 percent were stationed in a war zone at some time and 66 percent served their country for at least three years. Poverty, lack of support from groups or networks, and substandard housing put about 1.4 million veterans at risk for homelessness.

The Veterans Appeals Improvement and Modernization Act of 2017 will take at least a year to be implemented for several reasons. For example, the Department of Veterans Affairs does not use the Electronic Health Record used by the Department of Defense. Once adopted by Veterans affairs patient data will ultimately reside in one common system, enabling the immediate availability of service members' medical records and seamless care between the departments. Prior to his departure, Shulkin estimated the project to revamp the electronic medical records won't be completed for seven to eight years, and the full costs of the project were not known nor budgeted.

Trump signed three executive orders in May to address what he considers a bloated and inefficient federal workforce at the VA. VA workers and union members say the implementation is hurting workers — and veterans. The orders, in combination with a new VA accountability law signed by Trump last year, are creating chaos and hurting morale. According to the latest numbers from the VA, as of the end of June of this year, 2,743 employees have been fired since Trump took office, and there are thousands of open positions that now will not be filled. Keep in mind the devastating impact of PTSD on a generation of veterans. Not staffing suicide hotlines may cost the lives of veterans.

The care provided under the Choice program is not as immediate as Trump suggests, nor is it likely to be the "biggest thing" ever. Currently only veterans who endure waits of at least 30 days for an appointment at a VA facility are eligible to receive care immediately from private doctors at government expense, a standard that the VA is frequently unable to meet.